Synapse - Tumor genetic analyses of patients with metastatic renal cell carcinoma and extended benefit from mTOR inhibitor therapy

Tumor genetic analyses of patients with metastatic renal cell carcinoma and extended benefit from mTOR inhibitor therapy Journal Article

Authors:	Voss, M. H.; Hakimi, A. A.; Pham, C. G.; Brannon, A. R.; Chen, Y. B.; Cunha, L. F.; Akin, O.; Liu, H.; Takeda, S.; Scott, S. N.; Socci, N. D.; Viale, A.; Schultz, N.; Sander, C.; Reuter, V. E.; Russo, P.; Cheng, E. H.; Motzer, R. J.; Berger, M. F.; Hsieh, J. J.
Article Title:	Tumor genetic analyses of patients with metastatic renal cell carcinoma and extended benefit from mTOR inhibitor therapy
Abstract:	Purpose: Rapalogs are allosteric mTOR inhibitors and approved agents for advanced kidney cancer. Reports of clonal heterogeneity in this disease challenge the concept of targeted monotherapy, yet a small subset of patients derives extended benefit. Our aim was to analyze such outliers and explore the genomic background of extreme rapalog sensitivity in the context of intratumor heterogeneity. Experimental Design: We analyzed archived tumor tissue of 5 patients with renal cell carcinoma, who previously achieved durable disease control with rapalogs (median duration, 28 months). DNA was extracted from spatially separate areas of primary tumors and metastases. Custom target capture and ultradeep sequencing was used to identify alterations across 230 target genes. Whole-exome sequence analysis was added to investigate genes beyond this original target list. Results: Five long-term responders contributed 14 specimens to explore clonal heterogeneity. Genomic alterations with activating effect on mTOR signaling were detected in 11 of 14 specimens, offering plausible explanation for exceptional treatment response through alterations in two genes (TSC1 and MTOR). In two subjects, distinct yet functionally convergent alterations activated the mTOR pathway in spatially separate sites. In 1 patient, concurrent genomic events occurred in two separate pathway components across different tumor regions. Conclusions: Analysis of outlier cases can facilitate identification of potential biomarkers for targeted agents, and we implicate two genes as candidates for further study in this class of drugs. The previously reported phenomenon of clonal convergence can occur within a targetable pathway which might have implications for biomarker development beyond this disease and this class of agents. (C)2014 AACR.
Keywords:	temsirolimus; everolimus; interferon-alpha; trial; efficacy; pathways; selection; pik3ca mutations; intratumor heterogeneity; cancer
Journal Title:	Clinical Cancer Research
Volume:	20
Issue:	7
ISSN:	1078-0432
Publisher:	American Association for Cancer Research
Date Published:	2014-04-01
Start Page:	1955
End Page:	1964
Language:	English
ACCESSION:	WOS:000333900000029
DOI:	10.1158/1078-0432.ccr-13-2345
PROVIDER:	wos
PUBMED:	24622468
PMCID:	PMC4140619
Notes:	Article -- Source: Wos